中文摘要：

目的探讨常见呼吸道病毒特异性IgM抗体检测在儿童急性下呼吸道感染（ALRI）病原快速诊断中的实际应用价值。方法2009年3月至2010年9月在首都儿科研究所附属儿童医院就诊患儿207例，符合ALRI诊断标准，采集鼻咽分泌物用直接免疫荧光法（DFA）检测呼吸道合胞病毒（RSV）、腺病毒（ADV）、甲型流感病毒（IFVA）、乙型流感病毒（IFVB）和副流感病毒1、2、3型（PIV1、PIV2、PIV3）7种常见呼吸道病毒抗原，同时收集患儿急性期血清，采用ELISA和间接免疫荧光方法（IFA）分别检测血清中常见呼吸道病毒的特异性IgM。结果DFA、ELISA和IFA检测结果的阳性率分别为67．6％、57．5％和39．6％。ELISA和IFA与DFA检测结果符合率分别为21．7％和31．4％。ELISA和IFA与DFA检出病毒相符的患儿采血时发病天数平均值从高到低依次分别为ADV（12．0d）、PIV2（9．6d）、IFV（9．5d）、RSV（5．3d）和PIV3（15．0d）、ADV（9．2d）、RSV（7．4d）。3岁以下年龄组患儿血清IgM阳性和抗原检测的符合率较高。结论尽管血清IgM抗体检测的结果与抗原检测的结果有差异，但对儿科ALRI的早期快速诊断有一定的应用价值，尤其对于低年龄儿童；另外可以提供呼吸道病毒感染的血清学证据，如与病毒抗原诊断方法联合应用可提高病原确诊率。

英文摘要：

Objective The present study was designed to explore the practical application of the rapid etiological diagnosis by detecting specific IgM antibody against common respiratory viruses in children with acute lower respiratory infections （ALRI）. Method Clinical specimens including nasopharyngeal aspirates and serum of acute phase from hospitalized children were collected from 207 infants and children with acute lower respiratory infections from March 2009 to September 2010. Seven common respiratory virus antigens were identified from the collected nasopharyngeal aspirates by direct immunofluorescence assay （DFA）. ELISA was used to detect specific IgM antibody against RSV, ADV, IFVA, IFVB and PIV, while indirect immunofiuorescence assay （IFA） was used to detect specific IgM antibody against RSV, ADV, IFVA, IFVB, PIV1, PIV2 and PIV3 in collected acute phase serum. Result The overall positive rates to detect viral antigen by using DFA, ELISA and IFA was 67.6% , 57.5% and 39.6% , respectively. The consistent rate of ELISA and IFA versus accepted DFA were 21.7% and 31.4% , respectively. The average days from onset of the symptoms to blood sample collection for those with the consistent results by ELISA and DFA were 12.0 d for ADV, 9.6 d for PIV2, 9.5 d for IFV, and 5.3 d for RSV, respectively, and by IFA and DFA were 15.0 d for PIV3, 9.2 d for ADV, and 7.4 d for RSV, respectively. Among all age groups, the consistent rate of serum viral IgM and antigen detections was highest in children younger than 3 years old. Conclusion Although there were differences between serum IgM antibody and viral antigen detections, specific IgM antibody detection was of value in early and rapid etiological diagnosis of pediatric ALRI, especially for young children. It could provide serologic evidence of respiratory virus infection. The diagnostic rate of pathogen could be improved if it was used in combination with viral antigen diagnostic methods.